Kyu-Sun Choi1, Jae Min Kim1, Hyeong-Joong Yi1, Seon-Heui Lee2, Taeho Lim3, Wonhee Kim4, Youngsuk Cho4, Jin-Hwan Cheong1. 1. Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, South Korea. 2. Department of Nursing Science, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, 406-799, South Korea. sunarea87@gachon.ac.kr. 3. Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea. 4. Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, South Korea.
Abstract
PURPOSE: We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence. METHODS: We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmal SAH. Meta-analysis was performed using Review Manager 5.3. RESULTS: Eight randomized controlled clinical trials (RCTs) and 5 observational studies involving 2148 patients met the eligibility criteria. In the RCTs, statins were found to significantly reduce the occurrence of DINDs (relative risk (RR), 0.76; 95% confidence interval (CI), 0.61-0.94; P = 0.01), but did not significantly reduce poor functional outcomes (RR, 1.01; 95% CI, 0.87-1.16; P = 0.93) or mortality (RR, 0.80; 95% CI, 0.58-1.11; P = 0.18). In observational studies, statin use was not associated with any reduction in DINDs, poor outcome, or mortality. Meta-analysis of RCTs indicated a significant reduction in DINDs and mortality in patients with high-dose statin use (RR, 0.63; 95% CI, 0.42-0.95; P = 0.03; I 2 = 0%; and RR, 0.36; 95% CI, 0.15-0.86; P = 0.02; I 2 = 0%, respectively). CONCLUSION: The present meta-analysis suggests that statin use may prevent DINDs in patients with aneurysmal SAH. Based on our findings, the role of statins in improving neurological outcome was limited. However, the risk of DINDs and mortality decreased with higher statin doses in a dose-dependent manner. Hence, further well-designed RCTs with modified protocols in specific patients are required.
PURPOSE: We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence. METHODS: We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmalSAH. Meta-analysis was performed using Review Manager 5.3. RESULTS: Eight randomized controlled clinical trials (RCTs) and 5 observational studies involving 2148 patients met the eligibility criteria. In the RCTs, statins were found to significantly reduce the occurrence of DINDs (relative risk (RR), 0.76; 95% confidence interval (CI), 0.61-0.94; P = 0.01), but did not significantly reduce poor functional outcomes (RR, 1.01; 95% CI, 0.87-1.16; P = 0.93) or mortality (RR, 0.80; 95% CI, 0.58-1.11; P = 0.18). In observational studies, statin use was not associated with any reduction in DINDs, poor outcome, or mortality. Meta-analysis of RCTs indicated a significant reduction in DINDs and mortality in patients with high-dose statin use (RR, 0.63; 95% CI, 0.42-0.95; P = 0.03; I 2 = 0%; and RR, 0.36; 95% CI, 0.15-0.86; P = 0.02; I 2 = 0%, respectively). CONCLUSION: The present meta-analysis suggests that statin use may prevent DINDs in patients with aneurysmalSAH. Based on our findings, the role of statins in improving neurological outcome was limited. However, the risk of DINDs and mortality decreased with higher statin doses in a dose-dependent manner. Hence, further well-designed RCTs with modified protocols in specific patients are required.
Authors: Matthew J McGirt; John R Lynch; Augusto Parra; Huaxin Sheng; Robert D Pearlstein; Daniel T Laskowitz; Dale A Pelligrino; David S Warner Journal: Stroke Date: 2002-12 Impact factor: 7.914
Authors: E Sander Connolly; Alejandro A Rabinstein; J Ricardo Carhuapoma; Colin P Derdeyn; Jacques Dion; Randall T Higashida; Brian L Hoh; Catherine J Kirkness; Andrew M Naidech; Christopher S Ogilvy; Aman B Patel; B Gregory Thompson; Paul Vespa Journal: Stroke Date: 2012-05-03 Impact factor: 7.914
Authors: Sherry H-Y Chou; Eric E Smith; Neeraj Badjatia; Raul G Nogueira; John R Sims; Christopher S Ogilvy; Guy A Rordorf; Cenk Ayata Journal: Stroke Date: 2008-07-24 Impact factor: 7.914
Authors: Eyal Golan; Daniela N Vasquez; Niall D Ferguson; Neill K J Adhikari; Damon C Scales Journal: J Crit Care Date: 2012-11-26 Impact factor: 3.425
Authors: Johannes Walter; Martin Grutza; Markus Möhlenbruch; Dominik Vollherbst; Lidia Vogt; Andreas Unterberg; Klaus Zweckberger Journal: J Clin Med Date: 2022-04-05 Impact factor: 4.241